Mentally Ill Offenders: Treatment

My Lords, perhaps we may now return to the problem of disturbed offenders and what to do with them. First, I should like to thank my old and noble friend Lord Longford for raising this very difficult question. I agree with him and with the noble Baroness, Lady Faithfull, that it is one of the most difficult questions of all.

My noble friend Lord Longford dealt only with one half of the problem. His remarks centred on the more serious half whereas the noble Baroness. Lady Faithfull, dealt with the question very fully in relation to the petty side, which is the more tiresome half. I wish to say at the outset that I agree wholly with the suggested remedies from both sides. I want to talk very roughly in the first instance about the petty side and, secondly, about what the prison service and others are doing in relation to the more serious side.

A difficult question to answer is whether or not seriously disturbed people qualify under Section 47—I think it is Section 47—to he sent to a special hospital. My noble friend asked how one made that decision and suggested that it should be made by a tribunal. On the whole something of that kind seems to be necessary because quite often things seem to go wrong. At the other end of the scale of dangerousness are the offenders about whom the noble Baroness, Lady Faithfull, spoke. They are in fact just a certain number of the huge group of petty offenders who are filling our prisons to overflowing and whose numbers have been increasing year by year over the last 30 years. I suppose that something like 10 per cent. of those offenders might come into the category with which we are concerned. They are not only inadequate but, to use a word which I use quite affectionately, rather dotty. They are not dangerous criminal lunatics; they are people who cannot be relied upon to take the rational course for the simplest possible proposition. Often they are very charming and rather fun to deal with if one does not have to try to control them.

Everybody in penal reform circles has been saying for years that prison does nothing but harm and certainly can do no good to the ordinary inadequate. However, that is not the subject of this evening's debate. We shall talk about that matter on 30th November I hope, and we shall come back to it. At present we must consider that percentage of slightly dotty inadequates with whom it is particularly difficult for the prison service to deal. Discipline, which is invariably misunderstood by such people, turns in no time to cruelty. Such people need treatment and not discipline. In general the prison service is not equipped to give it. I am not certain that
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anybody is so equipped, because these people are very difficult to treat, but some effort has to be made.

The hospitals do not want them—and who can blame the hospitals? They must therefore be looked after in the community. If prison does damage and hospitals will not have them, only one solution remains: care by the community. That means—as the noble Baroness pointed out very strongly and better than I can do—a more generous provision of professional help added to the already fairly plentiful voluntary help. There are quite a number of different kinds of hospitals which deal with such people and it would not be difficult in any way to double the provision. In fact most of us believe that for under £l million it can probably be trebled. Of course it will not cost nothing but it will only cost about one-tenth of the cost entailed in further prison provision.

One could do worse than consider just for a minute the proper purposes of a hospital, a prison and an asylum. The proper functions of a prison are to punish by restricting liberty which at the same time protects society by removing the offender from circulation; to provide decent containment for all cases; and to aim at rehabilitation in cases in which it seems possible. The proper functions of a hospital are to relieve pain and disability and to attempt cure. The proper functions of an asylum—nowadays known as a special hospital or a long-stay mental hospital—are to protect the public from the patient and the patient from himself while looking after him or her in a kindly way and, in cases where prognosis is favourable, to attempt cure or at least amelioration of the condition.

As regards the serious offenders, apart from the appalling difficulties over diagnosis, the MacNaghten rules, questions of responsibility and so on, there is scope for dealing with them in special hospitals. The problem which the noble Earl raised; namely, how to decide which of them ought to go there, is not a question of provision; it is a question of understanding and expert views.

The second type of person—the petty or what I call the dotty offender—is something quite different. Here it is a question of provision. There is nowhere for these people to go. They cannot go to hospital because they are impossible to manage there. They do go to prison and there is a sad army which drifts in and out of prison on short sentences, and then goes in and out of hospital and back again into prison. We have to make some effort to deal with these people in an entirely different way, as the noble Baroness said. We should do so by giving the community enough professional and voluntary help to cope with difficult people of this kind in reasonably simple ways. I believe that all the machinery is there. For example, the Simon Community, which I have known for 30 years and have always much admired, specialises in the bottom rung of society. If one gave it a little more money, and possible an accountant, it could run 30 casual ward places which would be a credit to us and to the entire country. I do not believe that there is any difficulty except cash and the will to do it.

One issue which arises here is the question of drink. I believe that my noble friend Lord Soper will talk
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about this. However, the truth about drink is that it is part of the cause of the dottiness in a great many petty offenders.

Seventeen years ago an admirable report was published. I do not suppose a single person under 60 in the Home Office has ever looked at it. It was the report of the Home Office Working Party on Habitual Drunken Offenders. It recommended that,
persons who, under present arrangements would be arrested for being drunk in public should be taken by the police to special detoxification centres and there detained while they are dried out and any necessary medical and social investigation is carried out".
The report went on to suggest that they could then be sent to ordinary social work hostels.

Two experimental detoxification centres were set up in Leeds and Manchester in the 1970s. A more basic drying out centre was set up more recently in Birmingham. The Home Office recently withdrew funding from these centres and the Manchester centre has now closed. That is the response over 17 years to an important report which deals directly with the question that we are discussing tonight. I am not attacking the Minister. My own party, (as it then was) is just as guilty. For another six or seven years we did not do much. We accomplished a little, which has now been taken away. However, that is the kind of action that we must take.

I wish to add one comment because one is always misunderstood. Violence is an entirely different category. Most of the cases about which the noble Earl, Lord Longford, was talking are connected with violence. Therefore one is concerned with a special hospital or a prison, because these people are, and often remain—although not always, as the noble Earl has said—a danger to the public. However, I for one support severe sentences for all kinds of violence and for carrying weapons with intent to rob or injure. But I would not send inadequates to prison, even if there were no overcrowding. I regard it as a half-baked extravagance which can do no good and must do some harm. I hope that we may be able to develop this approach on 30th November.

I wish to turn for one minute to the prison department's initiatives over the dangerously disturbed offenders, which is more strictly the objective of the Question of the noble Earl, Lord Longford. Grendon constitutes the department's main effort. I shall be interested to hear from the Minister what else is being done in other parts of the service in this direction. Those in authority at Grendon have always insisted on selecting prisoners who would be both likely and willing to receive and benefit from its treatment. They have carried on a therapeutic regime, with some ups and downs, for over 30 years.

However, there is a new development which is of some interest to this present debate. Grendon has always had a small hospital of some 30 beds. This has now been transformed into an acute psychiatric unit at remarkably little cost and by the initiative of the people at Grendon. It is receiving cases from other prisons of men who have deteriorated mentally during sentence and is thus providing, in a numerically small way, for people who are not psychotic cases fit for transfer to such places as
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Broadmoor but who are in a bad way and need immediate psychiatric help. This has long been needed and now exists where nothing existed before. We shall follow its progress with great interest. I for one congratulate the prison service and those at Grendon on this initiative. I do not very often have the chance of congratulating the prison service. I shall therefore sit down quickly before it goes wrong.

My Lords, one of the best ways to ensure that progress is slow and halting on any topic is to select one that straddles the responsibilities of more than one department of state. It is something that bedevilled the work of the Pearson Royal Commission at the outset and it affects the topics that we are discussing today. I am well aware of the efforts which are being made to improve co-ordination between the Home Office and the Department of Health in this area, but it is not easy. In the meantime, I must express some sympathy for the noble Earl who has to reply to this debate and the wide-ranging issues which are being raised.

The noble Earl, Lord Longford, is to be congratulated on taking this opportunity to return to this important topic which raises so many issues. I propose to concentrate on questions affecting the management and policies of certain of the institutions involved. I begin with Broadmoor. Perhaps I may he forgiven for recalling that the Home Office used to have direct responsibility for Broadmoor. I recall visiting it for the first time in 1935. For the last decade I have been President of the League of Friends there—an admirable and devoted body of people. I find it quite fascinating that when there is a suggestion of building a new institution which in any way involves offenders there is almost always a great local hullabaloo. However, the village of Crowthorne, if anything, is rather proud of Broadmoor; and certainly there is a good deal of local voluntary effort.

On a point touched upon by the noble Earl, Lord Longford, there is also quite a bit of resentment at the persistent failure of the media—newspapers and television alike, if I dare mention television again—to understand just what Broadmoor is. I do not wish to steal the thunder of my noble friend Lord Shannon, but I must express my disappointment that in a magazine article even so shining a beacon of intelligent journalism as the Independent not only referred to this hospital as a criminal asylum but also (when this was taken up) could not see that it had greatly erred. It is perhaps unfair to pick out the Independent for special mention when the offence, such as it is, is so frequently committed by others. Certainly no one would ever guess from the media that some 20 per cent. of the patients at Broadmoor had never been anywhere near a criminal court.

I believe that there is some move afoot to set up a working party to try to do something about this, but they will find it pretty hard going. Perhaps the department could do a little more. It is fair to say that the department allowed access to the BBC some time ago to make a rather good documentary about
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Broadmoor but evidently the news editors do not watch such programmes.

Perhaps all this is not of the first importance. What is important is that Broadmoor should have a clear idea of its own function and just where it fits into the continuum of treatment of psychiatric patients as a centre of excellence providing highly skilled and highly professional medical treatment. Some splendid new buildings are going up there, even though they are tending to cost rather more than was thought. But it is not so clear what is now happening about the management of this important institution.

Some time ago plans were announced for setting up a special health authority for all four special hospitals, to come into being possibly next April and in the meantime to appoint general managers to each of the hospitals. But something remarkable has been happening at Broadmoor. It is not so much a wind of change that has been blowing there; it has been rather more like a Caribbean hurricane. The medical director has moved to another post and the doctor temporarily in charge, although an admirable individual, is of retirement age and would be the first to agree that he is holding a stop-gap appointment.

The management board that was set up not all that long ago with a great flourish of trumpets has in effect been suspended and it is now clear that its role was never properly thought out. The long-serving top administrator was called back from leave to be told that he was being moved to another appointment. The senior nursing officer decided to take early retirement. I have seen no sign of the promised general manager, but there is what is described as a task force beavering away under the chairmanship of an official in Whitehall. Morale among the staff, which is not too high, has not been helped by the results of the recent clinical grading review.

I am not alone in wondering why all this is happening. Does it have anything to do with a report on the hospital by the Health Advisory Service which is in the possession of Ministers? Is it a damning report? is it to be published with an indication of what is being done about it? What are the plans for appointing a general manager and defining his relationship with the top doctor when he in turn comes to be appointed? Is there to be a special authority for the four hospitals to be in being by next April? What plans are there for appointing somebody with local representation at each of the hospitals?

I could go on, but I think perhaps there are enough questions there to put to the Minister and I hope that he will be able to help, for there is a good deal of concern and puzzlement about what is happening at Broadmoor and why it has been so rushed.

It is a natural step from Broadmoor to ask about the semi-secure units aimed at filling the gap between the secure special hospitals on the one hand and the increasingly open-door ordinary psychiatric hospitals on the other. I shall not go over the agonising details of the abysmal early history following the initial theoretical approval of a programme for 1,000 places as recommended in 1974 in the interim report from Lord Butler's committee on mentally abnormal offenders, but I should like to know how that programme now stands. One is still
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hearing about new units being opened—the one at Milton Keynes for example—all these years after Lord Butler's urgent recommendations. Are facilities now available all over the country and how many beds have now been provided? Are there enough trained staff for them all to be in use? It is not only a question of what accommodation is provided, but also what use is being made of that accommodation.

Part of the original concept was that some patients who might otherwise go to a special hospital might instead go to one of these units and that some patients might be discharged from the special hospitals to one of these units as a kind of halfway stage. In both ways it was hoped that this would relieve pressure on the special hospitals. Can the Minister say how this has been working out? My impression is that the contribution has been rather disappointing, but I hope I am wrong. It has been suggested to me that one difficulty is that the units will not take anyone for longer than a maximum of two years and that there are then problems in getting an undertaking from an ordinary psychiatric hospital to take the patient thereafter.

Is there a policy of fixing a maximum stay of two years? If so, who so decided? Is there some means of evolving policy over all the units? What, for example, is the policy about mixing offenders and non-offenders? Has it been found necessary in the light of experience to modify some of the concepts of the Butler committee in putting forward its recommendations? We did not have very clear answers to some of these questions when we debated these topics a few years back on 4th July 1984, but there must by now be enough experience for us to be told how matters have worked out.

I have one final and very brief point about the hospitals. The Mental Health Act Commission—I am pleased to see the noble Viscount, Lord Colville of Culross, in his place—in its report for 1985–87, said that from such information as it had been able to amass there had been disappointingly small use made of Section 35 of the Mental Health Act 1983 for the courts to remand an accused person to hospital for a report on his mental condition rather than to prison. It wondered whether the new powers were sufficiently understood by the courts and by the doctors. It would be helpful to know if the Government have done anything about that and whether there are any signs of improvement.

In seeking information from the Government on all these points, I end by saying that, like the noble Earl, Lord Longford, I appreciate that we are talking about some of the most perplexing and difficult problems facing an enlightened society and that there are no easy solutions.

My Lords, I begin by reminding myself immediately of the concluding remarks of the last speaker. We are concerned with administrative problems which rest upon, I would suggest, a moral base. As my noble friend Lord Longford has already said, this raises all kinds of complex and difficult questions to which tentative answers are not a
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sufficient guarantee of a final solution. I presume to think that the problem of mental distress and mental disease is a kind of litmus paper which can offer a good deal of information on the basic problem of what is right and what is wrong, what is sin and what is circumstance.

I remember many years ago listening as a student to the great Dr. Inge. He was questioned as to whether there were any fundamental principles that distinguished right from wrong because in the opinion of the questioner, there were not. After some meditation Dr. Inge said; "I would advise you that mocking the insane is utterly wrong". That was a rather strange thing to say, but I believe that it is a clue to one of the answers which in this debate we can at least begin to proffer. The problem is variable according to circumstance. I believe that there are certain basic guidelines which should determine the accountability of the sinner, or of the man who disobeys the law, and the condition which is in some cases remediable and for which he cannot be blamed.

With little success but not sufficient I have been reading a good deal about the research which is being carried out in the realm of mental disease. I declare an interest though not an expertise. I am reasonably assured that there are three areas in which mental disease can at least be considered reasonably. The first is a condition promoted by physiological means. In some cases it is operable and subject to improvement by surgery and by other medical applications. Pre-frontal leucotomy is an example in that field. Secondly, modern research tends to attribute a great deal more of what are called "mental labyrinths" to conditions which are environmental and dependent on social relationships with other people. The third area is the vast area where as yet there is little precise knowledge. We should he grateful to the linguistic philosophers for reminding us that when one has labelled something one has not necessarily described it. In many cases the labelling of the symptoms of mental disorder is but a shorthand for a description of those symptoms. It is by no means an explanation of their source or their basic nature.

I should like to comment on what is required in each of the three areas. First, I shall deal with the area in which I have been practically involved for some years, that of trying to deal with and help the alcoholic. I am sure that one of the ways in which an alcoholic can be improved, if not cured, is by a reassessment of his status which can be the product of a new relationship with his fellows. At the same time, in the hostel of which I have had charge for many years, we have learned that unless we can combine that with a medical knowledge we shall, in many cases, be wasting a good deal of our time, if not all of it. The improvement in the therapies that can now he applied has reduced the number of total failures. I am glad to say that there has been an increase in the number of people who, provided that they are suitably sheltered, can make a compete recovery from a condition which in many cases in its latter stages was mental as well as spiritual. Are the Government prepared to face the necessary expense involved in the necessary programme of devoting more attention to the preliminary stages of therapy
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and hospital treatment, even though custody is required when the process is completed?

I turn to deal with the second area which is still in a state of exploration. There is a great deal of conflicting evidence but even more evidence is supplementary to a simple faith which I hold. It is that in many cases preventative medicine is in a new relationship with those who are insufficiently equipped to deal with the combativeness and the problems imposed on them by a broken society and the kind of world in which they live.

In that regard I heartily agree with what has been suggested; that there should be provision by the Government for hostels of various kinds and casual wards. It may interest the House to know that it was in a casual ward in one of the hostels where we were able to care for those who made a large measure of recovery. There they were surrounded by a different kind of environment from that in which they had found not escape but problems and, in many cases, disaster. I say frequently at open air meetings that if we can devote millions of pounds to the means of destruction, yet cannot afford to provide the necessary funds for the recuperation and treatment of those who are mental offenders because they are in a condition of mental stress, we have no right to call ourselves "civilised" and we should be ashamed of ourselves.

Finally, there is the area in which the competence of the analyst is still feeble and insufficient. It has been my experience over a long time that some kind of mental problem is almost universal among the down-and-outs. I do not say that with relish; I say it with a certain melancholy. My experience, which is wide though not profound, has shown over and over again that when one is looking at someone who can be regarded as rootless and down and out, one is looking at someone who is mentally afflicted as well as circumstantially embarrassed.

If that is so, I cannot but reflect that Christianity began with the casting out of devils. It may sound almost ludicrous to say that that is still the charge and opportunity of the Church. But let there be no mistake about it: the Church is in its less efficient days because no one would claim that it is doing more than a tithe of what it could do by the grace of God. Is it not strange that no one is talking about the relief and answer to the problem of mental errancy? No one is talking about the power of God's Holy Spirit to those who may be converted. I am a Methodist and John Wesley cast out devils up and down the country. I am not saying that that could immediately be repeated in our day and generation. There is a susceptibility to cynicism and unbelief which militate against it. However, I should not feel honourable if I did not include in the final category, of which mental distress is still a mysterious condition, that there is a great deal to be said for the argument that, if people were morally better, they would be more sensible and less subject to the rigours of mental distress and aberration.

It is in that field that I believe there is a case for a manifestation, in wider form that that which is now being expressed, of the caring society and for the
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renovation of some of the major principles of morality which are voiced as though they had come from the 19th century. So they did, but so did Dickens. I believe that they are an essential part in the recovery of many whose symptoms are analysable in the two previous terms in which I tried to describe them. Nevertheless, they are an improverishment of their spirit and a menace to the society in which we live. To put them in prison and then to forget about them is, in my judgment, a grievous loss of human compassion and a useless process.

In welcoming what has been said this afternoon I should like to make a plea on behalf of the Church. We could do a great deal more if we were so asked and enabled and in some cases we must be provided with the money. I mention in passing that we also lost our grant in the area of the recuperation of the alcoholic.

I conclude with a simple statement. I do not pretend to be an expert in the field of psychological research and I am no scientist. However, I believe that today there is an imperative need for a higher quality of social responsibility in the community. I am certain that today many are impoverished in their spirits because they suck in the sour air of a privileged society as it is separated from those who are unprivileged. This is a privatised society—and there is no mention of privatisation in the New Testament. We should have a society in which we can look upon the man who is mentally afflicted in some sense in the way in which a medieval village looked upon the village idiot—he was a member of the community. I believe that to give the errant and mental delinquent the sense that he is still a member of the community is not a sentimental attachment to other and more practical programmes but lies very near the essence of the case.

My Lords, the noble Earl, Lord Longford, is quite right to raise the issue of the mentally disordered this evening. However, my concern and the theme of my contribution, as very much seems to have been the theme of the noble Lord who has just sat down, is how society regards this group of people when they are discharged from their institutions.

At this point, I hope the noble Earl will forgive me, but in his speech he mentioned that I was chairman of the Matthew Trust. I am afraid that I have to tell him that, while I am very interested in the work of the trust—and it has kindly provided me with much of the information for my contribution this evening—I am not even a member of it let alone its chairman.

As your Lordships will know, when the 1959 Mental Health Bill was given Royal Assent special hospitals came into being such as Broadmoor, Rampton and others. Today there are some 2,000 patients in those hospitals many of whom have committed no offence. Since 1959 many hundreds have been discharged into the community. Some have re-offended and on sentence been put into prison and not redetained in their original special hospital for further treatment. However, others, while not having re-offended, have themselves asked
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to be re-admitted because society's attitudes to them were less than humane. Some have taken their own lives having been unable to cope with social prejudice.

Surely the spirit of the 1959 Mental Health Act was to hospitalise persons who, while mentally ill, had committed an offence and required medical and nursing care until they were again well enough to enter society. If so, the spirit of that Act is not in the main reflected in society's attitude to the formerly mentally disordered. When one observes the reports in the press, on radio and on television when a former patient of a special hospital re-offends, it becomes apparent why society, employers, trade unions and the like adopt hostile reactions to the mentally disordered in the community.

For example, whenever a former patient from Broadmoor Hospital re-offends, it is described by the media as the criminal lunatic asylum and the patients as the criminally insane, which are terms nearly 30 years out of date and which have no clinical or legal meaning today. Currently national newspapers and certain television and radio programmes have had to and are likely to pay heavy damages for defamation as jurors are tired of relentless editorial irresponsibility. I cannot help feeling that patients and former patients of special hospitals have some sympathy with those jurors' sentiments and may themselves adopt a similar course.

In asking his Question, the noble Earl referred to a Mr. Peter Thompson, who is the honorary secretary of the Matthew Trust, which has over the past 15 years done much to assist patients and former patients of hospitals as well as the mentally ill in prisons and victims of violent crimes. In 1959 Mr. Thompson founded the Pakenham-Thompson Committee, which considered the problems of ex-offenders and whose findings paved the way for the setting up of NACRO (the National Association for the Care and Resettlement of Offenders), the incorporation of the after-care service into the existing probation service and the use of probation associates to establish contact with long-term prisoners prior to their release. Today, in the same spirit, the Matthew Trust has announced that it is setting up a national media study working party to examine ways that recommendations can be made to protect the mentally disordered from media excesses.

One proposal which the Matthew Trust is examining is an amendment to the Rehabilitation of Offenders Act 1974 which could provide measures to curb media mis-reportage on a legal basis. I hope that the Home Secretary and the Secretary of State for Health might be persuaded to examine this thought and to support the trust's media working party, for it might be argued that few official measures have been initiated to assist the mentally disordered in terms of the national media.

Through Mr. Thompson the Matthew Trust has considerable experience in these matters. Five years after setting up the Pakenham-Thompson Committee, as the noble Earl, Lord Longford, wrote in the Month magazine, and strained with the overwhelming problems of ex-offenders, Mr.
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Thompson, following a serious attempt on his own life, committed an offence and was himself detained under Section 60 of the Mental Health Act 1959. He was in Broadmoor Hospital for four years. Since his discharge in 1969 he has re-established himself, as noted in the Guinness Book of Records. In this House he has been attributed with:
having done more for the mentally ill than any other layman",
although he, more than any other ex-patient from a special hospital, has been a victim of media excesses.

For example, when he was put on the Conservative Party's candidate's list the Daily Express reported that that party:
was scraping the bottom of the barrel".
When he was political adviser to an international relief agency and working in Uganda, Mr. Thompson was arrested, wrongly as it transpired, as a Kenyan spy. A press report in this country had the headline:
Ex-Broadmoor patient arrested".
In September last, as has already been referred to by the noble Lord, Lord Allen of Abbeydale, the Independent newspaper reporting on a speech made by Mr. Thompson before a distinguished audience, described him as coming out of:
Broadmoor. the Criminal Asylum".
As we have heard, that newspaper has unfortunately refused to correct that description of Broadmoor.

Of course not all matters of the press are wholly bad. The then Sir William Rees-Mogg, now a Member of your Lordships' House, when editor of The Times wrote to Mr. Thompson and said:
I will support anything you are associated with".
It could be argued that the number of letters from Mr. Thompson published in The Times on the subject of the mentally disordered while the noble Lord, Lord Rees-Mogg, was editor of The Times bore out that sentiment.

Recently, on 6th August last, Mr. Thompson had another letter published in The Times. With the leave of your Lordships I will quote the last paragraph:
a large proportion of those with mental illness histories have a higher IQ, are more creative and, because of their previous illness, are more discerning and through their illness have become wiser and more mature as well as understanding the many dimensions of human nature".
Mr. Thompson's letter was published at the time that Michael Dukakis, the Democrat contender for the White House, was alleged to have had depressions. Mr. Thompson in his letters to The Times argued that, depression or no, this should not bar a person from any leading activity in public life. I am happy to say that since the date of that letter Mr. Thompson has been invited to do 11 radio programmes for both the BBC and independent radio.

The mentally disordered do not deserve contempt. They merit understanding, not scorn; a hand of friendship, not isolation; and assistance to resume normal lives and be accepted—as indeed should all those who have been mentally ill.

My Lords, many speakers have already said that my noble friend has brought forward many questions relating to penal issues, but
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we would all agree that the matter before us this afternoon is perhaps the most sensitive and poignant of all.

My noble friend put forward some very important proposals to the Minister and I await his answers with keen anticipation. For example, I look forward to hearing what the Minister has to say about my noble friend's very worthwhile proposal that we should establish a mental offenders review tribunal similar to the Mental Health Review Tribunals. My noble friend also asked how many mentally disturbed people who are at present held in prison should be transferred to hospital. As he said, that is a difficult question to answer, but I hope the Minister will attempt to do so. My noble friend expressed concern that there are prisoners, with a high proportion from the ethnic minorities, who are transferred towards the end of their prison sentences to a mental hospital under Section 47 of the Mental Health Act. That too is a worrying aspect.

My noble friend and subsequent speakers have presented a picture of an extremely serious situation developing. As I said, I look forward to the Minister giving a positive and hopeful reply. I shall endeavour to add to the interesting contributions by presenting just a few observations and putting a few general questions to the Minister.

When I was preparing for this debate I wondered what the known figures in this sphere were. From my research I found the 1988 Home Office figure for those people in prison in spite of the fact that they satisfy the criteria for detention in hospital under the Mental Health Act 1983. I understand that the figure is 235. However, MIND, NAPO, Women in Prison and the New Bridge (of which I am chairman) all expressed concern about people in prison who have mental disorders which do not fall under the designated categories of the Mental Health Act.

I understand that in 1985 and in 1986 two special censuses were carried out by the prison medical officers of inmates serving sentences of six months or more who were considered to require specialised therapeutic facilities to deal with mental abnormalities which are not classified under the Mental Health Act. These censuses reveal that in 1985 there were 1,583 such people and at the end of 1986 there were 1,340. However, NAPO fears—and this has been repeated time and again in this debate—that there are thousands of offenders who suffer from depression, personality disorders, withdrawal, eating problems and so on. Those problems become aggravated as they go unrecognised and untreated in prisons. That subject was specifically referred to by the noble Lord, Lord Donaldson.

In the light of those figures I understand that the Home Office has commissioned a study, a psychological profile of the prison population, which is due to report in 1990. I should like confirmation of that from the Minister. I agree that that is to be welcomed, but in the meantime surely it would be wise to heed the request of my noble friend Lord Longford that the Government should presently monitor all those offenders in prison with mental
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health problems to try to assess their needs and provide some sort of treatment.

There is also concern about the high number of prisoners with mental health problems who are held on remand and the sharp rise in the number of those held in prision cells. Indeed, we have had some chilling reports in that respect in recent times. We all agree that this is a deplorable situation. In that context I ask the Minister, first, why a greater use of bail hostels or special hospital beds is not made for those remand prisoners. Secondly, why in the short term could not a system be introduced whereby there is always a doctor or trained police officer available who can identify and prioritise mentally abnormal prisoners when they arrive at police stations?

The noble Lord, Lord Allen, spoke with his usual level of authority and enormous experience—perhaps I should say expertise—about special hospitals, how these have been in a great state of turmoil and that important decisions on their future have to be made. I look forward to the Minister's reply to those questions.

In view of the concern of MIND about the adequacy of the patient's complaints procedure in special hospitals I ask the Minister one more question. What stage has the preparation of the complaints procedure for special hospitals reached? Is it envisaged that other agencies, apart from the Mental Health Act Commission and the Prison Officers Association, will be consulted about its content?

I should like to make a few comments relating specifically to mentally ill women who commit offences. The voluntary agency, Women in Prison, has made several suggestions on how to ameliorate the situation. To illustrate the problem the organisation has cited the case of a young woman which I think is typical of many cases. This young woman has a history of violence, mainly associated with a drink problem, and has suffered severe bouts of depression. She received psychiatric treatment in the past and she was discharged from hospital 12 months ago. Some months after being discharged she committed another offence and she was further recommended for hospital treatment. Her previous hospital refused to have her back and no other hospital would take her because of her offences. The special hospital would not take her. They said that she was unsuitable. There is no regional secure unit in her area so the judge had no alternative but to sentence her to a term of imprisonment.

The problem is that everybody agrees that she is ill and needs treatment which she will most certainly not recieve in prison. There is a high probability that she will be unable to cope with her prison sentence and that she will deteriorate sufficiently so that a special hospital will accept her and by that time she will be further damaged. She will then remain for an indefinite period. An example has been given of what can be done. Barnet General Hospital has a unique scheme operating between its psychiatric ward and the local police station.

When the police apprehend a woman or a man who is showing distress or bizarre behaviour, they contact the hospital before charging the person. The
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pyschiatric social worker and doctor go to the police station and assess whether the person is in need of psychiatric help or needs to get away from stresses at home or the community. If the doctor and the nurse feel that this is the case, they will take the person voluntarily into hospital for a few days or for a longer period.This scheme appears to work very well. It is a great relief to the police who are relieved not to have in their cells distressed and disturbed people, but most of all, it stops the most vulnerable people going to prison.

A suggestion was made which is very much in line with what the noble Baroness, Lady Faithfull, said in her very interesting speech. It was said that what is needed in many cases is not hospitals or remands to prisons for reports, but crisis centres which might well be run by the community. Those would be houses where women can go for varying periods of time for respite, and to receive practical help and counselling. In many cases, the women are caught up in an endless spiral of disaster, unhappiness and of matters going wrong, and if they were given some time to come to terms with their problems they might overcome them without further recourse.

I visited Holloway Prison a few days ago. I went to the C1 unit which is for mentally disturbed women. I was very happy to discover that the situation has very much improved since the adverse publicity of 1985–86. Now the nursing staff administer the unit themselves with the discipline staff only involved in a minor capacity. It is run more on the lines of a medical psychiatric ward. The women are out of their cells for very much longer periods and they make use of the therapeutic facilities available. The medical officer in charge with whom I spoke stressed the vital necessity of being permitted to employ sufficient numbers of nursing staff to maintain the improvement. He described how otherwise the present improved system could not be carried on. He also advocated the necessity for constant monitoring of the circumstances which lead to women appearing in court in the first place.

He made what to me appeared to be a very astonishing revelation. He finds himself, and others like him who have been in the mental health field for a long time now find themselves, treating in Holloway and Risley the very same women whom they had formerly treated in mental institutions in years gone by. "Fashions have changed", he said in a very philosophical way. While profoundly regretting this new and entirely inappropriate setting for the treatment of the mentally sick, he nevertheless made some very pragmatic suggestions as to how best to protect the interests of those vulnerable and highly unfortunate women in their new environment.

He stressed again the need for constant monitoring as regards the new circumstances in which those women were now finding themselves; how they had arrived there and what had led to it. He also stressed that there should be very much closer co-operation between the health and social services, the penal establishment, the police, local government officials and all the other bodies concerned. He feared that at present each body worked too independently of each
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other and that no clear picture of the new situation was evolving which would help the other bodies concerned.

This matter leads me to my last point regarding mentally unbalanced people and the policy of care in the community which has not been touched upon very much today. I believe that there can be little doubt of the direct connection between the over-accelerated dispatch of people from mental institutions, the rise in the crime rate and the prison population. Many voluntary organisations working in the field are extremely worried that the services in the community for such care are often—not always, they stress—grossly inadequate and underfunded with a lack of supporting social workers and of planned accommodation.

NAPO claims that this situation has reduced the options available to courts when sentencing the mentally-disturbed offenders. The courts have fewer non-secure mental hospitals to which to refer the less mentally-disturbed offender. Some courts will end up committing such offenders to prison which is exactly where they should not be. NAPO states that those who have been turned out into the community from hospitals will suffer a great deterioration in behaviour due to the lack of proper care. That could lead them to petty crime and land them in court facing a prison sentence.

The National Schizophrenia Fellowship is also very anxious about the number of schizophrenics who have left institutions and finished up in the courts and sometimes in prison. It has stressed that there was an important inquiry made into the care and aftercare of Miss Sharon Campbell and the results were published in July. There were many important recommendations. In particular, it was asked that the Government should accept recommendations, first, for DHSS clarification of the duties of health and local authorities under present legislation to provide aftercare for discharged mental hospital patients. The organisation wishes to know what duties they have.

Secondly, it is asked that health and local authorities should have a duty to provide aftercare for all former patients who have been suffering from mental disorders. Acceptance is asked for the recommendation for a specialist training course for social workers dealing with mentally-ill people in hospital or outside. Many social workers ignore the importance and the significance of schizophrenia. I believe that to be very important.

I hope that the Minister will have some answers bearing in mind the fundamental truth that no seriously mentally-disturbed person should be in prison and that those with less serious mental problems should be provided with adequate medical facilities or counselling while in prison. Many speakers have said already that it must be recognised and accepted that administering a system of punishment while at the same time procuring the health of those being punished are entirely incompatible objectives. To attempt to do so is not only to the detriment of a group of vulnerable people, but it also reflects a total failue on the part of a society that likes to think of itself as civilised.

My Lords, I should like to join other noble Lords in congratulating the noble Earl, Lord Longford, on putting down this very apt Unstarred Question. It further demonstrates the level of determination on penal matters which has long been associated with the noble Earl.

We all know that the prison system cannot pick and choose the people it receives from the courts, whether on remand or after sentence. Some people who are mentally disturbed do commit criminal offences. If they are brought to court, the court will weigh the relevant issues, including the protection of the public and the mental state of the offender, before judging the most appropriate disposal.

The key questions are these. Should more people who are suspected of having committed criminal offences and who appear to be mentally disturbed be filtered out of the criminal justice system altogether, or at least, if in fact charged, be diverted into the health and social services? Secondly, is adequate provision made within the prison system for the mentally disturbed people who are sent there? I should like to set out the Government's policy on these questions and to describe the efforts being made to carry it out.

To begin with, it is the Government's policy that in all suitable cases mentally disturbed offenders should be kept out of or transferred from prison. That is nothing new, but it bears repeating. In support of this, close liaison is maintained with the Deprtment of Health. Secondly it is the Government's intention to provide a level of care for mentally disturbed inmates consistent with the fact that they are in prison at all. In a number of cases, persons who are mentally disturbed may be diverted from the criminal justice system at an early stage. Especially when the alleged offence is quite a small one, and the person is already receiving psychiatric treatment, the police may exercise their power not to press charges. And, even if criminal proceedings are brought, the mentally disturbed defendant still has the same right as other defendants to be released on bail pending trial.

Non-custodial options are encouraged whenever possible, and many of these are designed to help offenders who need psychiatric support. In 1986, for example, the courts made 1,030 probation orders with a condition of residential or non-residential psychiatric treatment; and in the same year 836 hospital orders were made. Nevertheless, while the condition observed here happens to relate to psychiatric treatment, the courts' power to impose conditions at all is a general one and affects offenders in general regardless of their state of mind.

On the other hand, the Mental Health Act 1983 is specific. And it is through that Act that the judiciary has a range of powers for dealing with mentally disordered offenders without recourse to prison. It goes without saying that the courts should be fully aware of these powers. I am grateful to the noble Lord, Lord Allen of Abbeydale, for reminding us of this. Judges and magistrates also need to know what kinds of facilities are available in the community for the treatment, care and support of mentally
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disordered people. This was one of the areas on which the Home Office and the DHSS interdepartmental working group made recommendations. These departments are collaborating in the preparation of suitable guidance.

My noble friend Lady Faithfull asked me whether the Government now have plans to remove the category of psychopathic disorder from the Mental Health Act 1983. The Government carefully considered the response to their consultative paper on psychopaths and decided to retain the category of psychopathic disorder in the Act. We see no reason to change that view.

The noble Lord, Lord Allen, has drawn attention to the modest use by the courts of Section 35 of the Mental Health Act. Section 35 can be used by magistrates and Crown Courts when they wish to remand the accused to hospital for a report on his mental condition. In 1986, it was used in only 304 cases. I contrast that figure with the 7,055 reports prepared by prison medical officers on people remanded to prison for psychiatric assessment. This underscores the need for guidance to which I have already referred. I shall touch on that point again in a moment.

As your Lordships will know, the regional secure unit programme was started following the recommendation of the Butler Committee. By the end of 1982 all regional health authorities had interim secure arrangements. Now there are permanent units in all but one of the 14 regions, and I understand that plans are under way for facilities in this last region. The regional secure units are intended to take patients whose treatment can be effected within two years. In answer to the noble Lord, Lord Allen of Abbeydale, regional secure units have developed skills to care both for mentally disordered offenders and mentally disordered people who have not offended but need care in security.

The total number of places currently available—518—is much less than that recommended by the Butler Committee. The Department of Health is firmly encouraging regional health authorities to develop in their regions a comprehensive range of facilities including, where the need has been shown to exist, additional RSU places. The department is also encouraging the development of places for people who need care in lesser security over a longer period of time than two years. As the noble Lord, Lord Donaldson, said, there may well also he a need by the longer-term patient for some form of sanctuary. This is a matter into which the Department of Health and the Home Office are looking.

I should like to turn to the special hospitals service run by the Department of Health. Your Lordships will know that there are now new management plans. These plans have already affected Broadmoor Hospital. The prime objectives of this service are to protect the public and to give the patient the right treatment and a good quality of life. The special hospital service is intended to be closely linked to the psychiatric services provided by district health authorities. Special hospitals themselves are to be used as training centres to encourage trained staff in
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various branches of psychiatry. The hospitals will also be used for research into forensic psychiatry and related conditions. A new special health authority is planned to oversee the operations of the four hospitals. Perhaps I may give some details to the noble Lord, Lord Allen, who inquired about them.

As well as overseeing the four hospitals, the new special health authority will also be able to appoint their managers. These general managers have yet to be appointed but they will provide much needed leadership at hospital level and will head multi-disciplinary advisory groups. The managers will be accountable to the special health authority for the performance of the groups as a whole in achieving the SHA's priorities. Before general managers are appointed, Ministers intend to promulgate a new statement of national policy for the special hospitals service, building on the aims and objectives that I outlined a moment ago. With the safety of the public always in mind, this will, so far as possible, minimise the existing geograpical, professional and service isolation of the special hospitals by emphasising and strengthening the existing vital links to the full range of psychiatric services provided by the hospital and community health services, the family practitioner service, the social services, and to the prison service, the prison medical service and the courts.

Once the new special health authority is in place and the general managers appointed, the intention is to abolish the Special Hospitals Services Board within the Department of Health and to adjust the role of both the department and the three local hospital boards. The new arrangements will be kept under constant review to ensure that they are working properly. Ministers are considering placing a time limit on the operation of the new special health authority with the aim of forging even stronger links with the National Health Service and the prison service.

The noble Baroness, Lady Ewart-Biggs, asked me about the special hospitals' complaints procedure. This is still under active consideration and will be introduced as soon as possible.

I should like briefly to refer again to Broadmoor, about which the noble Lord, Lord Allen, has spoken. The activities of the Broadmoor Hospital Board were suspended during August and the operational management of the hospital is in the hands of a specially formulated task force whose best known member is Dr. Jimmy Savile. Dr. Savile has been involved with the work of Broadmoor Hospital for many years and is now devoting his considerable talents to ensuring that the hospital functions smoothly during this difficult interim period before the new special health authority comes into being.

On a more general point, the noble Earl, Lord Shannon, mentioned the working party of the Matthew Trust. My right honourable friends the Secretaries of State for the Home and Health Departments will of course be happy to look at the Matthew Trust proposals if such proposals are sent to them.

As I have already observed, a person directed to prison by the courts cannot properly be turned away.
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The prison population grows relentlessly and the feeling of prison staff is that the segment of the prison population who are mentally disturbed also grows. Many will not be detainable under the Mental Health Act, as the noble Baroness, Lady Ewart-Biggs, reminded us. A census taken by prison medical officers on 1st October 1986 of sentenced inmates serving six months or more considered to require specialised therapeutic facilities (whether or not they might be detained under the Act) produced the figure of 1,564.

Some commentators have sought to demonstrate a causal link between the planned closure of psychiatric hospitals and the numbers of mentally disturbed offenders in the prison system. The Government's policy of "Care in the Community", sets out to do three things, whenever it can—to help those suffering from mental illness to get well more quickly; to help people to stay well longer; and to help people avoid becoming ill in the first place. We are going about doing this by trying to identify ways of preventing mental illness, and by creating a comprehensive range of services within each district for those who fall ill.

As a consequence of the policy of creating locally-based services, some of the old mental hospitals have closed, and others are scheduled to close. But I cannot emphasise too strongly that hospital closure is not an end in itself. Closures should only ever occur where better alternative facilities have already been developed.

As your Lordships are aware, there are concerns about the Government's policy and its implementation. In particular, that patients are discharged without proper trouble taken for their future care. And that our policy does net do enough for those whose need might he described as "sanctuary", sometimes in conditions of security.

I have to tell your Lordships that we do not know to what extent these criticisms are justified but we have an uneasy feeling that they are justified, at least in some parts of the country. And we recognise that our lack of systematic information is, in itself, a major defect. My honourable friend the Parliamentary Under-Secretary of State for Health has set in hand work to get a clear picture of the situation throughout the country.

My Lords, so we can all be quite clear about what the noble Earl is saying perhaps I may ask this. As I understand it, he is saying that there is an independent element and, that being so, presumably the results of this will be published and be publicly available. Is that correct?

The Earl of Dundee

No, my Lords, I do not think that that will in fact happen. Indeed, I cannot say that.

My Lords, why not? Why should the results not become publicly available? What is the secrecy as regards this?

The Earl of Dundee

My Lords, I am delighted that the noble Lord encourages us to make everything as open as possible, which is what he should be doing. I do not think there will be anything secret about the matter; but when I say that the answer is no, that is my information and I take it that it is a procedural matter.

My Lords, as I understand it, the information will not be published. However, as the noble Earl is also saying that there is no secrecy in the matter, perhaps he can relate his observations directly to that apparent paradox.

The Earl of Dundee

My Lords, I hope I can reassure the noble Lord. It is a factual matter and I shall write to him explaining the details.

I turn now to the remarks made by my noble friend Lady Faithfull. I am well aware of her experience and work in this general field and most grateful to her for her comments. She suggested—indeed her remarks were reinforced by the noble Lords, Lord Donaldson and Lord Soper—that the departments and voluntary organisations should get together to examine the need by the homeless and rootless former patients of some kind of sanctuary.

The valuable work undertaken by many voluntary organisations is well recognised. The suggestion is an extremely important one which I welcome and I shall ensure that it is brought to the attention of both departments.

The noble Baroness, Lady Ewart-Biggs, referred to prisoners in police cells. Industrial action by some branches of the Prison Officers Association has pushed the number of prisoners in police cells to very high levels in recent months. The Government find that situation quite unacceptable. On 29th September the Home Secretary invited the POA national leaders to work with prison service management to bring a rapid end to industrial action across the prison system. He made clear the Government's intention to take vigorous action if a significant improvement was not shortly forthcoming. Encouraging progress has since been made. The POA branches in the four prisons recently involved in industrial action ended their refusal to admit prisoners two weeks ago. The prisons are now building up to capacity again and that is causing the numbers in police cells to reduce also.

My Lords, I am sorry to interrupt the noble Earl again, but when he says "building up to capacity", in my opinion they have not been below capacity for the last 10 years.

The Earl of Dundee

My Lords, I do not think that I would wish the noble Lord to infer that.

Six-monthly returns by prison medical officers of the numbers in prison who are considered to be detainable in hospital show a downward trend with occasional marked fluctuations. The latest figures
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available show that at 31st March 1988, there were 235 in this seriously disturbed category, comprised almost equally of sentenced and unsentenced inmates. This was 110 fewer than reported for September 1987. Your Lordships will be glad to note that reduction.

The noble Earl, Lord Longford, cast some doubt on our method of computing those figures and, in introducing references to the USSR, he slightly suggested that we might be using some political criteria. Indeed, I thought that he was reminding us of Darkness at Noon by Koestler. However, I can reassure the noble Earl that although our figures may not be perfect, they are arrived at professionally and I believe that the reduction which I have just mentioned is a genuine one.

My Lords, I am afraid the noble Earl's figures are totally unconvincing; they are quite meaningless. I do not know how he has obtained them. If it was by asking medical officers—most of whom are certainly not psychiatrists—what they feel about the prisoners, I am afraid that is not in any way good enough.

The Earl of Dundee

My Lords, I accept the point of view that the noble Earl has put forward. I also respect the fact that it is a point of view which he has not put forward for the first time. There is always an element of doubt in figures of this nature that we give. All we can do is to attempt to give them in as professional a way as we can and to try to arrange that it is only professional and independent people who arrive at them.

I am also able to report a welcome continuing increase in the number of mentally disordered offenders who are transferred to hospitals under Section 47 and 48 of the Mental Health Act. One hundred and three were transferred in 1982 and 208 in 1987.

The noble Earl, Lord Longford, raised questions about the timing of transfers under Section 47 of the Mental Health Act and the ethnic origin of those transferred. That information is not readily available but I shall write to him on the matter.

The noble Earl also raised the issue of review tribunals for mental offenders. Leaving aside the absence of detailed proposals, we see no compelling need or advantage in such tribunals. However, I shall certainly draw the suggestion to the attention of my right honourable friend.

There are at least two good reasons for obtaining the numbers of mentally disordered offenders in prison. They can let us know whether there is enough of the right kind of provision within the prison system itself. They can also show the extent to which the policy of diversion from the prison service is working. From them we learn how valuable existing specialist facilities are, such as those of Grendon Psychiatric Prison—and I am grateful to the noble Lord, Lord Donaldson, for what he has said about Grendon. The interest of the noble Lord in this important establishment, and his contribution to its work as a past Chairman of the Board of Visitors over many years, are well known to Members of this House, and have
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been much appreciated by the management and staff of Grendon, by the prison department generally, and by successive Home Office Ministers. As the noble Lord has indicated, there has been a number of wholly beneficial developments recently. I join with him in looking forward to further progress. I assure the noble Lord, and the House, that Grendon continues to occupy a valued place in the prison service.

The censuses also showed the desirability of recruiting into the prison medical service more nurse qualified officers, and especially those trained in the care of the mentally disturbed. There is another fact that we should keep before us. Certainly the prison medical service has a distinct role. But equally we should avoid duplicating the range of facilities which exist in the community. The prison medical service uses many specialists from the NHS. In 1986 to 1987 almost 12,500 inmates were referred to NHS consultant psychiatrists for opinion or treatment. The two services work closely together.

Of course, not all is brightness and light. On occasion, prison medical staff may feel, with justification, that it takes far too long for some consultant psychiatrists to visit patients when the object is to enable the court, or the Home Secretary, to authorise removal to hospital under the Mental Health Act. In that context the noble Earl, Lord Longford, referred to the coroner's recommendations following the inquest on the suicide of Samuel Carew. The coroner was particularly concerned that no specialist psychiatrist from the NHS had seen Samuel Carew in Brixton prison before his death, despite four requests from medical staff there for such a visit.

Your Lordships are aware of the interim letter sent by the department to the coroner in response to his recommendations. A copy was placed in the Library. The most important of the recommendations were directed at speeding the response of NHS specialists when prisoners are considered to need their attention. The departments are looking into ways in which that can be achieved. The noble Baroness, Lady Ewart-Biggs, mentioned one useful development, which is to have duty psychiatrists at courts on the model of a scheme presently in use in Peterborough.

We may well then need more nurse qualified staff in the prison medical service. Yet that implies no criticism of existing staff. Their work and care, especially with this particularly challenging group of inmates, deserves a great deal of praise. Some 40 per cent. of full-time medical officers have a qualification in psychiatry. Recruitment policy is geared to building upon that figure. I am also glad to be able to report that the hospital and nursing staff of the prison medical service includes at the moment 109 trained to varying degrees in the care of mentally disturbed people. The Director of Prison Medical Services is introducing a more carefully planned distribution of future recruiting with that training. And that measure will also affect how inmates themselves will be allocated across the prison system.

But of course we must strike a balance. It is one thing to recognise that the existing capability needs
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strengthening. At the same time it is vital that the courts are not misled into believing that eventually this capability will amount to an alternative disposal to hospital in the community.

For the development of policies for the long term, we await the commissioned report of Professor Gunn. This report is on the psychiatric profile of the sentenced prison population. It is well underway. I can confirm to the noble Baroness, Lady Ewart-Biggs, that it will take a further two years to complete. Professor Gunn's terms of reference also invite him to comment upon existing arrangements in the prison service for the management, care and treatment of mentally disordered inmates and to suggest ways of doing better.

Possible future research under consideration includes decision-making by the courts in relation to Section 37 of the Mental Health Act in making hospital orders. This would cover the question of the number of orders which would have been made had facilities been available.

A second possible study would be into the remand prison population with particular reference to procedures for courts to obtain medical reports on defendants; the working of Section 35 of the Act and the scope to speed up the process—for example, by the use of duty psychiatrists at court.

Your Lordships will be familiar with the report of the interdepartmental working group of officials to which I referred earlier. Alongside the implementation of the group's recommendations, consideration of how best the Government's objectives can be effected continues.

The noble Earl, Lord Longford, referred to the need of those who have been in one form or another of mental institution to enjoy the same degree of confidentiality when they come out as that enjoyed by inmates of prisons. I was very interested in that suggestion, as indeed I was in the whole speech of the noble Earl, Lord Shannon, when he gave examples of how people who have been in mental institutions have a lot to offer society when they come out. I shall certainly pass on those comments to my right honourable friend.

Finally, I hope that I have been able to get across that the Government have a clear policy in respect of mentally disturbed people who commit or are accused of having committed criminal offences. We make no pretence of satisfaction in the present level of implementation of that policy. We are complacent neither at the extent of their diversion from the prison system nor at the quality of arrangements for their care if sent to prison. But we are able to demonstrate a resolve to put into effect and build upon the improvements I have described.

My Lords, we are all very grateful to the Minister for having answered so many of our questions. But I put a few questions to the Minister—I refer particularly to those questions put to me by the National Schizophrenia Fellowship—which have not been answered. I should be grateful if he would read what I have said and write to me on those points.

My Lords, I apologise to the noble Baroness, and indeed to other noble Lords if they put questions which I have not addressed. I shall certainly write to the noble Baroness and to any other noble Lord whose question I have left unanswered.